小针刀配合膝关节锻炼防治膝骨关节炎的临床研究  

Clinical study on the treatment of knee osteoarthritis with small needle knife combined with knee joint exercise

作　　者：施敏 田天照 蔡迎峰 刘保新 黄鹏 秦启宁 陈锦 罗培杰 张鑫 朱秀梅 周意 SHI Min;TIAN Tianzhao;CAI Yingfeng;LIU Baoxin;HUANG Peng;QIN Qining;CHEN Jin;LUO Peijie;ZHANG Xin;ZHU Xiumei;ZHOU Yi(Affiliated Hospital of Traditional Chinese Medicine,Guangzhou Medical University,Guangzhou 510016,China)

机构地区：[1]广州医科大学附属中医医院,广州510016

出　　处：《吉林中医药》2024年第12期1493-1496,共4页Jilin Journal of Chinese Medicine

基　　金：国家自然科学基金(81774378);广州市中医药和中西医结合科技项目(20222A010025);广州市科技计划项目(2023A03J0311);第四批广东省名中医师承项目(粤中医办函〔2023〕85号)。

摘　　要：目的基于传统经筋结聚理论,研究小针刀疗法配合膝关节伸缩锻炼对轻中度膝骨关节炎(KOA)患者的临床疗效,总结膝关节的经筋结聚点分布规律。方法将符合标准的60例轻中度KOA患者随机分为对照组和治疗组,各30例,对照组口服艾瑞昔布片、外敷活血化瘀药物的跌打膏以及进行股四头肌收缩锻炼;治疗组使用口服艾瑞昔布片联合小针刀治疗,并配合膝关节伸缩锻炼,2组治疗均持续2周。观察2组患者在接受治疗前后膝关节Lysholm功能积分、IL-6及TNF-α的变化,并对所有患者膝关节的经筋结聚点记录,分析、总结其分布规律。结果经治疗,在膝关节Lysholm评分方面,治疗组的改善程度明显优于对照组(P<0.01);治疗组IL-6、TNF-α二者治疗前后的变化有统计学意义。总结分析经筋结聚最集中的部位是内外侧副韧带起止点和鹅足,其次是腘绳肌起止点,再次是髌骨四角,最少是髌韧带起止点。结论经筋结聚点在膝关节内外侧副韧带起止点和鹅足出现的概率最大,其次是腘绳肌起止点。该结论可以为膝关节的针刀治疗提供重要参考。使用小针刀疗法配合膝关节伸缩锻炼对轻中度膝骨关节炎患者临床疗效更满意,具有较高的临床推广价值。Objective To study the clinical efficacy of small needle knife therapy combined with knee joint stretching exercise in patients with mild to moderate knee osteoarthritis(KOA)based on the traditional theory of tendon aggregation,and to summarize the distribution pattern of tendon aggregation points in the knee joint.Methods A total of 60 mild to moderate KOA patients meeting the standards were randomly divided into a control group and a treatment group,with 30 cases in each group.The control group was treated with oral administration of iricoxib tablets,external application of Dieda ointment,and quadriceps muscle stretching exercise.The treatment group was treated with oral administration of iricoxib tablets and small needle knife therapy combined with knee joint stretching exercise.The treatment lasted for two weeks in both groups.The Lysholm function scores of the knee joint,serum levels of IL-6 and TNF-αwere observed in the two groups of patients before and after treatment.At the same time,the tendon aggregation points of all patients'knee joints were recorded,and their distribution patterns were analyzed and summarized.Results After treatment,the improvement of Lysholm scores was significantly better in the treatment group than that in the control group(P<0.01).There was statistically significant diff erence in the level changes in IL-6 and TNF-αin the treatment group before and after treatment.The most concentrated areas of tendon aggregation are the starting and ending points of the inner and outer collateral ligaments and the goose foot,followed by the starting and ending points of the hamstring muscle,the four corners of the patella,and the starting and ending points of the patellar ligament for the least.Conclusion The study shows that the probability of tendon aggregation is highest at the starting and ending points of the medial and lateral collateral ligaments of the knee joint and the goose foot,followed by the starting and ending points of the hamstring muscle.This conclusion can provide important

关 键 词：经筋理论 膝骨关节炎 小针刀 功能锻炼 

分 类 号：R684.3[医药卫生—骨科学]